Archive

Today is the first-ever Menstrual Hygiene Day! Though my excitement has occasionally been met with raised eyebrows and puzzled expressions, I couldn’t be more thrilled for the global attention to this crucial yet neglected issue.

You see, like diarrhea, menstruation is a taboo topic: a fact which works against the awareness needed to address their associated health risks. We make significant sacrifices for the sake of polite conversation.

If you move in global health circles, you may have had the good fortune to meet soccer star (and ONE Campaign Global Health Policy Director) Erin Hohlfelder. In her recent blog, she reflects on how access to lifesaving immunizations gave her the opportunity to be happy and healthy in the game of life, which still eludes too many children. The GAVI Alliance exists to help level the global playing field, and this week, ONE Campaign launched the game plan for donors in the new World Cup-themed report, Going for Goal: Immunisation and the Case for GAVI.

All these sports analogies make me reflect on my own athletic career… as an unwilling participant in my grade school physical education class. That is, until hockey flipped the switch in me. I became a maniac, relentlessly chasing the ever-moving puck, blind to the confusion of my teammates and to irrelevant distinctions like “offense” and “defense.” I was a zealot on a mission, and I had no time for strategy. Good intentions notwithstanding, it wasn’t the best use of my newfound passionate energy.

It turns out what’s true in the hockey (or soccer) field is true in the global health field, too. Each player contributes unique strengths to build a winning team. It’s why we constantly talk about an integrated approach to diarrheal disease: prevention efforts (water and sanitation, vaccination, breastfeeding, and nutrition) must team up with treatment efforts (ORS/zinc, and eventually new drugs). We would inevitably suffer losses if everyone focused on a singular approach, forgetting that each player – each intervention – is necessary in the game.

Saving 5 million children with vaccines is an ambitious but achievable goal. If we can dream even bigger with a combined approach, why wouldn’t we?

You might think that coming home from abroad after attending a conference on the leading cause of bacterial pneumonia only to find your grandmother severely ill with bacterial pneumonia sounds too ironic to be true. But that’s what precisely happened to me in March.

I came home fresh off the plane eager to see my grandmother (who lives with me), but as I entered her room, I knew instantly that something was wrong. Sunken into the couch, a pale, weak, and scared woman looked back at me where my normally vibrant grandmother should have been. She’d had what seemed like a common cold earlier in the week, but the illness had suddenly taken a turn for the worse and she was having difficulty breathing. A trip to the emergency room later confirmed our fears. Bacterial pneumonia had set in—a disease particularly threatening to people my grandmother’s age (which I shall tactfully leave undisclosed.)

According to the attending physicians at the hospital, pneumonia probably didn’t just strike out of thin air. More likely, my grandmother was a victim of something called co-infection—a simultaneous infection by separate diseases. Her symptoms suggested that an initial viral infection had weakened her immune system, making her more susceptible to the pneumonia-causing bacteria that put her in the hospital.

My grandmother, pictured here with her great grandson, made a full recovery thanks to quick, affordable access to medical care.

Her case, though a standout ordeal for our family, isn’t necessarily unique. Children, the elderly, and others with weak or compromised immune systems are particularly susceptible to co-infections. The risk of co-infections are even greater in the developing world where malnutrition, unsanitary living conditions, and lack of access to disease prevention and treatment tools (like vaccines and antibiotics) leave people especially vulnerable to contracting multiple diseases at once.

Many diseases can be culprits of co-infections. For pneumonia specifically, one commonly cited risk factor is influenza. Non-respiratory diseases like diarrhea have also been linked to increasing the risks of pneumonia—meaning that the two deadliest diseases for children worldwide are capable of working both alone and together to kill.

The co-infection dynamic is one of many compelling reasons why integrated approaches to tackling the world’s most devastating diseases are so important. More and more, these kinds of strategies are making inroads. In the case of diarrhea and pneumonia, the global health community is currently implementing the Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea, which simultaneously leverages health interventions across these diseases. Such tools include basic sanitation, safe drinking water, hand washing, nutrition, antibiotics, breastfeeding, clean cook stoves, antibiotics, zinc, oral rehydration solution, and vaccines. Alone, this integrated effort could avert the deaths of over two million children by 2015.

After three days of breathing treatments and antibiotics in the hospital, my grandmother went home feeling better than she did before she got sick. She was lucky. We had affordable, state-of-the-art medical care just minutes from our house. But many around the world aren’t so lucky. Tailoring global health strategies to tackle diseases simultaneously, particularly in the world’s most underserved regions, is one way of making prevention and treatment tools go farther against risk factors like co-infections. Since diseases can team up together to take lives, why shouldn’t we do the same… to save them?

To the average passerby, Dar es Salaam is a busy, bustling city. With a lovely coastline, welcoming people, and so much culture, it seems Tanzania is humming. And undoubtedly, it is. However, for all of Tanzania’s development and progress—like many Sub-Saharan African countries—there remains a hidden burden that impedes the country’s ability to fully recognize it’s potential.

Child mortality rates, particularly those from pneumonia and diarrhea, are not decreasing rapidly enough for Tanzania to meet its Millennium Development Goal 4 target of a two-thirds reduction. Children continue to succumb to these preventable killers; a vicious tether to slow progress and development concerns.

However, as outlined in PATH’s recent Tanzania policy report, a few key updates to the country’s policies and strategies could save more children’s lives. In honor of the Global Week of Action, here are six ways Tanzania can turn policies and plans into lifesaving action:

1. Register a co-packaged Oral Rehydration Product (ORS) and zinc product: Research has shown that packaging ORS and zinc together into a “diarrhea treatment kit” improves the chances that a caregiver will understand that zinc is an essential component of diarrhea treatment. Registration is crucial to make this co-packaged product available in Tanzania.

2. Officially revise Integrated Management of Childhood Illness (IMCI)guidelines to identify diarrhea treatment as ORS plus zinc: It’s commonly understood—and recommended by the Integrated Global Action Plan for Prevention and Control of Pneumonia and Diarrhea (GAPPD)—that comprehensive diarrhea treatment means to use ORS and zinc together. However, it’s important that Tanzania’s national guidelines officially define diarrhea treatment according to global best practices.

3. Revise IMCI guidelines to denote amoxicillin as first line treatment: By using amoxicillin dispersible tablets as first line pneumonia treatment, Tanzania has been a leader in following recommendations outlined by WHO and the GAPPD. Now it’s time to officially align national guidelines with global best practice and list amoxicillin dispersible tablets.

4. Allow community case management by Village Health Workers (VHWs): Children in rural Tanzania should be able to access the same high quality care as those in urban areas. Policy updates are needed to lift the ban on stocking VHWs with treatment commodities and to bring trained, supervised VHWs into the more remote areas of Tanzania to help close the equity treatment gap between rural and urban communities.

5. Allow Accredited Drug Dispensing Outlets (ADDOs) to provide treatment: While ADDOs are already trained and supervised by the Tanzanian government, they only serve as a referral mechanism to other providers–even if they are the only provider in the community. If policies were updated to allow ADDOs to stock diarrhea and pneumonia treatment commodities themselves, more communities could have access to these life-saving drugs.

6. Allocate funds to treatment of diarrhea and pneumonia: Government prioritization and resources go a long way in Tanzania. Now is the time for the government to take action by specifically highlighting diarrhea and pneumonia as a child health priority and allocating specific funds for comprehensive treatment.

These policy changes won’t happen overnight. In today’s world of quick-fixes and immediate satisfaction, we can’t lose sight of long-term investments to make lasting change. Now is the time for the government of Tanzania to take global action and chart a new path to reduced child mortality. The lives of Tanzania’s children depend on it.

Pneumonia and diarrhea are the leading killer diseases of children globally. National policies that incorporate the latest global standards of care can help drive down these numbers. Kenya adopted an integrated national diarrheal disease policy in 2010, and today, PATH and partners are encouraging the country’s adoption of global recommendations for pneumonia treatment.

I recently became an aunt to a boisterous little boy, well, that’s if you count 2 years as recent! Since then, I’ve developed an even more personal interest in supporting work that focuses on preventable childhood diseases that continue to contribute to my country’s less-than-ideal child mortality rates. One such disease is pneumonia. Globally, pneumonia kills more children below age five than any other disease and this statistic is largely mirrored in Kenya. Pneumonia accounts for roughly 16% of child mortalities in Kenya, or in other words, approximately 122,000 children under five each year.

Why is Kenya falling behind on its commitments to reducing child mortalities, and why does pneumonia remain a ‘silent killer’ of children? Only half of children with suspected pneumonia receive the recommended antibiotic. This very simple statistic is symptomatic of the breakdown of the UNICEF/WHO framework which highlights 3 essential steps to reducing child mortality due to pneumonia. Basically, to better address pneumonia in children, the first step is to accurately recognize that a child is unwell with pneumonia; however, many caregivers cannot correctly identify the tell-tale signs of pneumonia (fast breathing and difficult breathing). Secondly, caregivers then have to immediately seek appropriate care from providers that can accurately diagnose and treat pneumonia. Finally, since the majority of pneumonia cases in Kenya are caused by bacteria, a full course of appropriate antibiotics should be provided as the recommended, affordable and effective treatment.

So how or where does policy change make a difference in how we address childhood pneumonia? To start off, by adopting the global recommendations on how pneumonia is classified and treated. WHO now recommends amoxicillin as first-line treatment; however, Kenya’s treatment guidelines still reflect the old treatment regimen, which called for co-trimoxazole. While the country is currently scaling up integrated community case management (iCCM), which includes amoxicillin as first-line treatment, this is not reflected in the care provided by facility level health care providers.

PATH is currently working in partnership with the Kenya Pediatric Association (KPA) and UNICEF to advocate for this critical policy change that will align national treatment guidelines with current evidence and global recommendations. A critical component of this work is supporting the Ministry of Health in conducting a critical analysis of the global and local evidence that backs this change in treatment guidelines. But this is only a first step. Next we have to work on ensuring that the commodity is available in the country. This means having amoxicillin registered and included on the Essential Medicines List specifically for treatment of childhood pneumonia. And finally, work has to go into harmonizing treatment guidelines and training curricula for health providers to ensure standardized treatment within the country.

Kenya’s recent step in introducing the pneumococcal vaccine is a step in the right direction, but as I have highlighted, more needs to be done. Implementing these important policy changes will institutionalize the simple actions we can take to save our children. So as I watch my nephew thrive and grow stronger and faster, I remain committed to ensuring that mothers and caregivers around the country can do the same with their little ones.